Supplemental Material, sj-docx-1-cpa-10.1177_0706743720986786 for Emerging New Psychiatric Sympto... more Supplemental Material, sj-docx-1-cpa-10.1177_0706743720986786 for Emerging New Psychiatric Symptoms and the Worsening of Pre-existing Mental Disorders during the COVID-19 Pandemic: A Canadian Multisite Study: Nouveaux symptômes psychiatriques émergents et détérioration des troubles mentaux préexistants pendanturant la pandémie de la COVID-19: une étude canadienne multisite by Rebecca Robillard, Alexander R. Daros, Jennifer L. Phillips, Meggan Porteous, Mysa Saad, Marie-Helene Pennestri, Tetyana Kendzerska, Jodi D. Edwards, Elizaveta Solomonova, Rajiv Bhatla, Roger Godbout, Zachary Kaminsky, Addo Boafo and Lena C. Quilty in The Canadian Journal of Psychiatry
Objectives. Suicide is the second leading cause of adolescent deaths and may be linked to difficu... more Objectives. Suicide is the second leading cause of adolescent deaths and may be linked to difficulties with inhibitory and emotional processing. This study assessed the neural correlates of cognitive inhibition during emotional processing in adolescents hospitalized for a suicidal crisis. Methods. Event-related potentials were recorded during an emotional Go/NoGo task in 12 adolescents who attempted suicide and 12 age- and sex-matched healthy controls. Results. Compared to the control group, the suicidal group showed significantly reduced positivity at the time of the P3d (difference waveform reflecting NoGo minus Go trials) in response to happy and neutral, but not sad stimuli. For happy stimuli, this group difference was restricted to the right hemisphere. Further analyses indicated that the suicidal group had a reversed pattern of P3 amplitude in response to inhibition, with lower amplitudes in the NoGo compared to the Go conditions. Suicidal symptoms severity strongly correlated...
There is growing support for the implementation of physical activity in the treatment of individu... more There is growing support for the implementation of physical activity in the treatment of individuals with serious mental illness. The purpose of this study was to investigate whether affective response or enjoyment were related to adolescents' willingness to perform high-intensity interval training (HIIT) as an adjunct to mental health treatment. These secondary analyses examined data from 28 adolescent psychiatric inpatients who performed a single session of HIIT. Patients completed the Positive and Negative Affect Schedule (PANAS) before and after the exercise session. Following exercise, patients were asked to provide ratings from 1-10 for their enjoyment of HIIT and willingness to perform HIIT before therapy. Linear regression analyses were used to examine the association between enjoyment/affect responses to HIIT and willingness to perform HIIT before therapy, controlling for age and sex. Enjoyment of HIIT significantly explained willingness to perform HIIT when adjusting f...
Auditory temporal resolution, measured through gap detection, is critical for the perception of s... more Auditory temporal resolution, measured through gap detection, is critical for the perception of speech. A time-efficient multi-deviant paradigm has previously been developed for gap detection. The purpose of the present study was to determine if this multi-deviant paradigm could be used for gap detection during NREM sleep. ERPs were recorded in 10 young adults while awake and during the first two hours of NREM sleep. A multi-deviant paradigm was employed with six different deviants varying in gap duration, ranging from 2 to 40 ms. During waking, a DRN was observed for the 10, 20, 30 and 40 ms gaps. The DRN was absent during sleep. A P2 was present in NREM for the 20, 30 and 40 ms gaps followed by a P3a to the 30 and 40 ms gaps. An N350 was observed following the 10, 20, 30 and 40 ms gaps. Previous studies have reported significant ERPs to gaps having shorter durations than the present study. The multi-deviant paradigm may not be suitable for the determination of gap threshold during sleep. Nevertheless, it provides an exquisite means to determine perceptibility and the extent of processing of longer duration, supra-threshold gaps during sleep.
Purpose This article describes steps taken by a mental health inpatient multidisciplinary team to... more Purpose This article describes steps taken by a mental health inpatient multidisciplinary team to develop a clinical pathway for the assessment and management of suicidality in a pediatric psychiatric inpatient unit. Patients and Methods The setting for this project is a 19-bed inpatient psychiatry unit providing care for children and adolescents (6–17 years of age) in a tertiary care pediatric hospital in Ontario, Canada. Three Lean methodologies were used: 1) The A3 process was used to articulate a problem statement and help clarify expectations, determine goals, and uncover, address and encourage discussion of potential issues; 2) Process mapping was used to show how work process activities are sequenced from the time of the patient’s admission to discharge; and 3) Standard work, where consideration was given to the breakdown of the work into categories which are sequenced, organized and repeatedly followed. Generally accepted methodologies for developing clinical pathways were u...
To determine the physical literacy, defined as the capability for a physically active lifestyle, ... more To determine the physical literacy, defined as the capability for a physically active lifestyle, of children with medical conditions compared with healthy peers, this multicenter cross-sectional study recruited children with medical conditions from cardiology, neurology (including concussion), rheumatology, mental health, respirology, oncology, hematology, and rehabilitation (including cerebral palsy) clinics. Participants aged 8–12 years (N = 130; mean age: 10.0 ± 1.44 years; 44% female) were randomly matched to 3 healthy peers from a normative database, based on age, gender, and month of testing. Total physical literacy was assessed by the Canadian Assessment of Physical Literacy, a validated assessment of physical literacy measuring physical competence, daily behaviour, knowledge/understanding, and motivation/confidence. Total physical literacy mean scores (/100) did not differ (t(498) = –0.67; p = 0.44) between participants (61.0 ± 14.2) and matched healthy peers (62.0 ± 10.7). ...
There is increasing evidence that, in adolescence, attentional bias plays a critical role in the ... more There is increasing evidence that, in adolescence, attentional bias plays a critical role in the vulnerability for suicidal behaviour. No studies to date have investigated the neurophysiological correlates of attentional bias in adolescent suicidality. The present study uses event-related potentials (ERPs) to investigate such processing in inpatient adolescents admitted for an acute suicide crisis using an Emotional Stroop Task (EST). In this task, participants are asked to name the colour of words varying in emotional valence (positive, negative, neutral, suicide-related). Suicidal individuals are hypothesised to be more preoccupied by the context of the suicide-related stimuli, which may interfere with their ability to perform the colour naming task. Seventeen adolescents with acute suicidal behaviour and 17 age- and gender-matched healthy controls performed an EST while ERPs were recorded. Suicide attempters showed increased reaction times to suicide-related words compared to oth...
Background: The coronavirus disease 2019 (COVID-19) pandemic has caused global disruptions with s... more Background: The coronavirus disease 2019 (COVID-19) pandemic has caused global disruptions with serious psychological impacts. This study investigated the emergence of new psychiatric symptoms and the worsening of pre-existing mental disorders during the COVID-19 pandemic, identified factors associated with psychological worsening, and assessed changes in mental health service use. Methods: An online survey was circulated between April 3 and June 23, 2020. Respondents were asked to complete mental health questionnaires based on 2 time referents: currently (i.e., during the outbreak) and in the month preceding the outbreak. A total of 4,294 Canadians between 16 and 99 years of age were subdivided based on the presence of self-reported psychiatric diagnoses. Results: The proportion of respondents without prior psychiatric history who screened positive for generalized anxiety disorder and depression increased by 12% and 29%, respectively, during the outbreak. Occurrences of clinically ...
BackgroundUnderstanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it ... more BackgroundUnderstanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it unfolds is crucial to identify the most critical needs and to inform targeted interventions.MethodsThis population survey study presents cohort characteristics and baseline observations linked to the acute-mid phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress as measured by the Cohen’s Perceived Stress Scale (PSS) collected cross-sectionally between April 3 and May 15, 2020. A multivariate linear regression model was used to identify factors associated with stress changes relative to pre-outbreak estimates.Findings6,040/6,685 (90·4%) participants filled out at least 1/3 of the survey and were included in the analyses. On average, PSS scores increased from 12·9+6·8 before the outbreak to 14·9+8·3 during the outbreak (p<0·001). The independent factors associated with stress worsening were: having a me...
Introduction: Suicide is the second leading cause of death among adolescents. Suicidal behavior i... more Introduction: Suicide is the second leading cause of death among adolescents. Suicidal behavior is associated with impairments in attention. Attention can be directed toward relevant events in the environment either actively, under voluntary control, or passively, by external salient events. The extent to which the risk for suicidal behavior affects active and passive attention is largely unknown. Methods: Event-related potentials (ERPs) were recorded while 14 adolescents with acute suicidal behavior and 14 healthy controls performed an auditory 3-stimulus oddball task. The task consisted of standard (80%), target (10%), and novel (10%) stimuli. The participants were instructed to press a button upon presentation of the target. The novel stimuli were unexpected and irrelevant to the target detection task. Results: Accuracy of target detection was slightly but significantly reduced in the suicidal group. There were no significant differences in the amplitude of the target-N2 or -P3b ...
A. Basic and Translational Sleep Science VIII. Sleep and Circadian Interactions no differential i... more A. Basic and Translational Sleep Science VIII. Sleep and Circadian Interactions no differential impact on morning sleep inertia in task performance and subjective feelings (p>0.05). Conclusion: The results indicate that the artificial dusk may be a useful light modality in improving sleep quality and shortening sleep latency in healthy sleepers. While this light setting has no influence on sleep inertia after awakening in the morning. The effect of sleep inertia does vary with cognitive domains.
Background Primary care physicians and child and adolescent psychiatrists often treat sleep distu... more Background Primary care physicians and child and adolescent psychiatrists often treat sleep disturbances in children and adolescents with mood disorders using medications off-label, in the absence of clear evidence for efficacy, tolerability and short or long-term safety. This study is the first to report Canadian data about prescribing preferences and perceived effectiveness reported by child and adolescent psychiatrists regarding medications used to manage sleep disturbances in children and adolescents with depression. Methods Canadian child and adolescent psychiatrists were surveyed on their perception of effectiveness of a range of medications commonly prescribed for sleep disturbances, their ranked preferences for these medications, reasons for avoiding certain medications, and perceived side effects. Results Sixty-seven active child and adolescent psychiatrists completed the survey. Respondents reported noting significant sleep issues in 40% of all their patients. Melatonin an...
Exogenous melatonin can be used to treat sleep disturbance in adults, children, and adolescents. ... more Exogenous melatonin can be used to treat sleep disturbance in adults, children, and adolescents. While its short-term use is considered safe, there are some concerns that long-term use might delay children's sexual maturation, possibly by disrupting the decline in nocturnal melatonin levels that occur at the onset of puberty. This narrative review aimed to summarize some of the current knowledge about the potential effects of exogenous melatonin on puberty. We found no clinical studies that experimentally tested the effects of melatonin on pubertal timing in children, but we reviewed the small number of observational studies. We also drew on animal data to try to answer our question. The photoperiod and melatonin-mediated seasonal transitions in sexual activity and breeding in some mammals across the seasons have been used as a model of sexual development in mammals, including humans. The switch from non-sexual activity (in the non-breeding period) to sexual activity (in the breeding period) has been likened to the onset of puberty as there are similarities between the two. We conclude that to investigate an association between melatonin and pubertal timing, it will be important to conduct long-term randomized controlled trials of latency age children and also examine the cellular and systemslevel interactions between melatonin and kisspeptin, a recently identified neuropeptide with a locus of action at the gonadotropin releasing hormone neurons that is important in contributing to the timing of puberty onset.
Abstract Introduction Inhibitory control is essential for treatment of, and recovery from mental ... more Abstract Introduction Inhibitory control is essential for treatment of, and recovery from mental illness. An acute bout of exercise has been shown to improve inhibitory control in healthy adolescents. Purpose The primary goal was to examine the effect of an acute bout of high-intensity interval training on inhibitory control both immediately and 30-min post-exercise in adolescents hospitalized for a mental illness. Methods Participants were recruited at the Children's Hospital of Eastern Ontario. Participants performed exercise and control conditions in a randomized, counterbalanced manner. The Colour-Word Stroop Task (CWST) assessed Interference Cost (reaction time) pre, post, and 30-min post for each condition (exercise/control). The exercise condition included a 12-min HIIT circuit consisting of body weight exercises performed in a 1:1 work to rest ratio. The control condition involved reading magazines. Repeated-measures ANOVA evaluated changes in the interference cost and accuracy measures of the CWST. Results There was a significant interaction between condition and time for the interference cost measure, F(1.6,43.3) = 13.6, p Conclusion HIIT was able to improve inhibitory control by increasing response efficiency rather than improving the overall ability to respond correctly. The impact of pre-therapy HIIT to enhance focus and reduce impulsive thoughts and behaviours may improve adolescent patients’ response to mental health treatment.
The present study examines processes associated with intrusions into consciousness during an unco... more The present study examines processes associated with intrusions into consciousness during an unconscious state, natural sleep. The definition of sleep is still much debated. Almost all researchers agree that sleep onset represents a gradual loss of consciousness of the external environment. For sleep to be beneficial, it needs to remain as undisturbed as possible. Nevertheless, unlike other unconsciousness states, sleep is reversible. For purposes of survival, it is critical that the sleeper be able to "detect" and perhaps become conscious of highly relevant biological or personal information. Therefore, even in sleep, the brain must decide whether a new incoming stimulus is relevant and if so, may require an arousal to wakefulness, or whether it is irrelevant and can be gated to prevent disruption of sleep. Event-related potentials (ERPs) were used to measure the extent processing of auditory stimuli some of which elicited an ERP component, the P3a, in the waking state. The P3a is associated with processes resulting in the interruption of frontal central executive, leading to conscious awareness. Very little research has focused on the occurrence of the P3a during sleep. A multi-feature paradigm was used to examine the processing of a frequently occurring "standard" stimulus and six rarely occurring different "deviant" stimuli during wakefulness, NREM, and REM sleep. A P3a was elicited by novel environmental sounds and white noise bursts in the waking state, replicating previous studies. Other deviant stimuli (changes in pitch, intensity, duration) failed to do so. The ERPs indicated that processing of the stimuli that did not elicit a P3a in wakefulness were much inhibited during both NREM and REM sleep. Surprisingly, those deviants that did elicit a P3a in wakefulness continued to do so in stage N2 and REM sleep. The subject did not, however, awaken. These results suggest processes leading to consciousness in wakefulness may still remain active during sleep possibly allowing subjects to act on potentially highly relevant input. This may also explain how sleep can be reversed if the stimulus input is sufficiently critical.
OBJECTIVE/BACKGROUND Rates of suicide attempts in Canadian youths are concerning. Adolescence is ... more OBJECTIVE/BACKGROUND Rates of suicide attempts in Canadian youths are concerning. Adolescence is a sensitive period for the emergence of both sleep and mood problems, two major risk factors for suicidality. This naturalistic study aimed to define the sleep profile of adolescents under the combined influence of suicidality, depression and pharmacotherapy during hospitalization for a suicidal crisis. PATIENTS/METHODS Seventeen suicidal adolescents (15.0 + 1.2years, 82% females) with major depression were recruited from a Canadian pedopsychiatric inpatient unit. Seventeen non-depressed adolescents were retrospectively collated from another database (15.0 + 1.1years, 83% females). None of the participants had a history of sleep disorders or significant medical conditions. RESULTS Compared to controls, suicidal adolescents had a longer sleep onset latency (Z = -4.5, p < 0.001), longer REM latency (Z = -3.2, p = 0.001), higher percentage of NREM1 sleep t(33) = -2.6, p = 0.020), and higher REM density (Z = -2.8, p = 0.004) than controls. Higher REM density correlated with higher CDI-II scores (r = 0.55, p = 0.27) A significant interaction indicated that the two groups had similar NREM3 percentages in the first two-thirds of the night, but that the suicidal group had significantly lower NREM3 percentage than the controls in the last third of the night (F(2,66) = 3.4, p = 0.041). CONCLUSIONS Significant sleep abnormalities were observed during hospitalization for a suicidal crisis in a sample of depressed and mostly medicated adolescents. This included sleep initiation and REM sleep latency abnormalities, shallower sleep and high REM density. Future studies should decipher the relative effects of depression, suicidality and medication on sleep. These findings stress the need to address sleep disturbances in the management of suicidality in adolescents.
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent, 2018
To review sexual health screening practices during admission to an adolescent psychiatry unit. Re... more To review sexual health screening practices during admission to an adolescent psychiatry unit. Retrospective chart review of randomly selected youth admitted over a one-year period (2013). Data extracted included demographics, reasons for admission, sexual health history, as well as any comorbid behaviours noted. The main outcome measure was whether sexual health details were documented at any time during admission; if so, this information was extracted for analysis. Statistical analysis was done using univariate associations and logistic association. Mean age of subjects (n=99, 79 females and 20 males) was 15.24 years (SD = 1.30). Most common reasons for admission were suicidal gestures/self harm (n=57, 58%) and mood disorders (n=53, 54%). Thirty-seven patients (37%) had sexual health information documented in their charts. No demographic variables were significantly associated with being asked sexual health questions. Patients who had mood disorder diagnoses had 6 times the odds (...
American journal of medical genetics. Part B, Neuropsychiatric genetics : the official publication of the International Society of Psychiatric Genetics, Jan 20, 2017
White matter lesions have been described in patients with PTEN hamartoma tumor syndrome (PHTS). H... more White matter lesions have been described in patients with PTEN hamartoma tumor syndrome (PHTS). How these lesions correlate with the neurocognitive features associated with PTEN mutations, such as autism spectrum disorder (ASD) or developmental delay, has not been well established. We report nine patients with PTEN mutations and white matter changes on brain magnetic resonance imaging (MRI), eight of whom were referred for reasons other than developmental delay or ASD. Their clinical presentations ranged from asymptomatic macrocephaly with normal development/intellect, to obsessive compulsive disorder, and debilitating neurological disease. To our knowledge, this report constitutes the first detailed description of PTEN-related white matter changes in adult patients and in children with normal development and intelligence. We present a detailed assessment of the neuropsychological phenotype of our patients and discuss the relationship between the wide array of neuropsychiatric featu...
This review examines biological rhythms in persons with obsessive-compulsive disorder (OCD) and t... more This review examines biological rhythms in persons with obsessive-compulsive disorder (OCD) and their potential relevance to the pathophysiology and treatment of this disorder. In some cases of OCD, the expression of affective, cognitive, and behavioral symptoms may be influenced by circadian and seasonal rhythms, and this could possibly interact with other neurophysiological factors. Further work is required to characterize circadian profiles linked to OCD, but findings thus far highlighted delays in both the sleep-wake cycle and melatonin secretion, as well as reduced circadian rhythmicity of body temperature. It is proposed that these changes in behavioral and endogenous rhythms may increase one's vulnerability to obsessivecompulsive symptoms. Accordingly, obsessive-compulsive symptoms appear to be more severe in individuals with lower circadian amplitude and often worsen in the afternoon and evening. An increasing number of studies reported encouraging outcomes following the integration of sleep and circadian-based treatments in the management of OCD. There is a need for larger controlled trials evaluating the efficacy of chronotherapies in the context of OCD.
Supplemental Material, sj-docx-1-cpa-10.1177_0706743720986786 for Emerging New Psychiatric Sympto... more Supplemental Material, sj-docx-1-cpa-10.1177_0706743720986786 for Emerging New Psychiatric Symptoms and the Worsening of Pre-existing Mental Disorders during the COVID-19 Pandemic: A Canadian Multisite Study: Nouveaux symptômes psychiatriques émergents et détérioration des troubles mentaux préexistants pendanturant la pandémie de la COVID-19: une étude canadienne multisite by Rebecca Robillard, Alexander R. Daros, Jennifer L. Phillips, Meggan Porteous, Mysa Saad, Marie-Helene Pennestri, Tetyana Kendzerska, Jodi D. Edwards, Elizaveta Solomonova, Rajiv Bhatla, Roger Godbout, Zachary Kaminsky, Addo Boafo and Lena C. Quilty in The Canadian Journal of Psychiatry
Objectives. Suicide is the second leading cause of adolescent deaths and may be linked to difficu... more Objectives. Suicide is the second leading cause of adolescent deaths and may be linked to difficulties with inhibitory and emotional processing. This study assessed the neural correlates of cognitive inhibition during emotional processing in adolescents hospitalized for a suicidal crisis. Methods. Event-related potentials were recorded during an emotional Go/NoGo task in 12 adolescents who attempted suicide and 12 age- and sex-matched healthy controls. Results. Compared to the control group, the suicidal group showed significantly reduced positivity at the time of the P3d (difference waveform reflecting NoGo minus Go trials) in response to happy and neutral, but not sad stimuli. For happy stimuli, this group difference was restricted to the right hemisphere. Further analyses indicated that the suicidal group had a reversed pattern of P3 amplitude in response to inhibition, with lower amplitudes in the NoGo compared to the Go conditions. Suicidal symptoms severity strongly correlated...
There is growing support for the implementation of physical activity in the treatment of individu... more There is growing support for the implementation of physical activity in the treatment of individuals with serious mental illness. The purpose of this study was to investigate whether affective response or enjoyment were related to adolescents' willingness to perform high-intensity interval training (HIIT) as an adjunct to mental health treatment. These secondary analyses examined data from 28 adolescent psychiatric inpatients who performed a single session of HIIT. Patients completed the Positive and Negative Affect Schedule (PANAS) before and after the exercise session. Following exercise, patients were asked to provide ratings from 1-10 for their enjoyment of HIIT and willingness to perform HIIT before therapy. Linear regression analyses were used to examine the association between enjoyment/affect responses to HIIT and willingness to perform HIIT before therapy, controlling for age and sex. Enjoyment of HIIT significantly explained willingness to perform HIIT when adjusting f...
Auditory temporal resolution, measured through gap detection, is critical for the perception of s... more Auditory temporal resolution, measured through gap detection, is critical for the perception of speech. A time-efficient multi-deviant paradigm has previously been developed for gap detection. The purpose of the present study was to determine if this multi-deviant paradigm could be used for gap detection during NREM sleep. ERPs were recorded in 10 young adults while awake and during the first two hours of NREM sleep. A multi-deviant paradigm was employed with six different deviants varying in gap duration, ranging from 2 to 40 ms. During waking, a DRN was observed for the 10, 20, 30 and 40 ms gaps. The DRN was absent during sleep. A P2 was present in NREM for the 20, 30 and 40 ms gaps followed by a P3a to the 30 and 40 ms gaps. An N350 was observed following the 10, 20, 30 and 40 ms gaps. Previous studies have reported significant ERPs to gaps having shorter durations than the present study. The multi-deviant paradigm may not be suitable for the determination of gap threshold during sleep. Nevertheless, it provides an exquisite means to determine perceptibility and the extent of processing of longer duration, supra-threshold gaps during sleep.
Purpose This article describes steps taken by a mental health inpatient multidisciplinary team to... more Purpose This article describes steps taken by a mental health inpatient multidisciplinary team to develop a clinical pathway for the assessment and management of suicidality in a pediatric psychiatric inpatient unit. Patients and Methods The setting for this project is a 19-bed inpatient psychiatry unit providing care for children and adolescents (6–17 years of age) in a tertiary care pediatric hospital in Ontario, Canada. Three Lean methodologies were used: 1) The A3 process was used to articulate a problem statement and help clarify expectations, determine goals, and uncover, address and encourage discussion of potential issues; 2) Process mapping was used to show how work process activities are sequenced from the time of the patient’s admission to discharge; and 3) Standard work, where consideration was given to the breakdown of the work into categories which are sequenced, organized and repeatedly followed. Generally accepted methodologies for developing clinical pathways were u...
To determine the physical literacy, defined as the capability for a physically active lifestyle, ... more To determine the physical literacy, defined as the capability for a physically active lifestyle, of children with medical conditions compared with healthy peers, this multicenter cross-sectional study recruited children with medical conditions from cardiology, neurology (including concussion), rheumatology, mental health, respirology, oncology, hematology, and rehabilitation (including cerebral palsy) clinics. Participants aged 8–12 years (N = 130; mean age: 10.0 ± 1.44 years; 44% female) were randomly matched to 3 healthy peers from a normative database, based on age, gender, and month of testing. Total physical literacy was assessed by the Canadian Assessment of Physical Literacy, a validated assessment of physical literacy measuring physical competence, daily behaviour, knowledge/understanding, and motivation/confidence. Total physical literacy mean scores (/100) did not differ (t(498) = –0.67; p = 0.44) between participants (61.0 ± 14.2) and matched healthy peers (62.0 ± 10.7). ...
There is increasing evidence that, in adolescence, attentional bias plays a critical role in the ... more There is increasing evidence that, in adolescence, attentional bias plays a critical role in the vulnerability for suicidal behaviour. No studies to date have investigated the neurophysiological correlates of attentional bias in adolescent suicidality. The present study uses event-related potentials (ERPs) to investigate such processing in inpatient adolescents admitted for an acute suicide crisis using an Emotional Stroop Task (EST). In this task, participants are asked to name the colour of words varying in emotional valence (positive, negative, neutral, suicide-related). Suicidal individuals are hypothesised to be more preoccupied by the context of the suicide-related stimuli, which may interfere with their ability to perform the colour naming task. Seventeen adolescents with acute suicidal behaviour and 17 age- and gender-matched healthy controls performed an EST while ERPs were recorded. Suicide attempters showed increased reaction times to suicide-related words compared to oth...
Background: The coronavirus disease 2019 (COVID-19) pandemic has caused global disruptions with s... more Background: The coronavirus disease 2019 (COVID-19) pandemic has caused global disruptions with serious psychological impacts. This study investigated the emergence of new psychiatric symptoms and the worsening of pre-existing mental disorders during the COVID-19 pandemic, identified factors associated with psychological worsening, and assessed changes in mental health service use. Methods: An online survey was circulated between April 3 and June 23, 2020. Respondents were asked to complete mental health questionnaires based on 2 time referents: currently (i.e., during the outbreak) and in the month preceding the outbreak. A total of 4,294 Canadians between 16 and 99 years of age were subdivided based on the presence of self-reported psychiatric diagnoses. Results: The proportion of respondents without prior psychiatric history who screened positive for generalized anxiety disorder and depression increased by 12% and 29%, respectively, during the outbreak. Occurrences of clinically ...
BackgroundUnderstanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it ... more BackgroundUnderstanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it unfolds is crucial to identify the most critical needs and to inform targeted interventions.MethodsThis population survey study presents cohort characteristics and baseline observations linked to the acute-mid phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress as measured by the Cohen’s Perceived Stress Scale (PSS) collected cross-sectionally between April 3 and May 15, 2020. A multivariate linear regression model was used to identify factors associated with stress changes relative to pre-outbreak estimates.Findings6,040/6,685 (90·4%) participants filled out at least 1/3 of the survey and were included in the analyses. On average, PSS scores increased from 12·9+6·8 before the outbreak to 14·9+8·3 during the outbreak (p<0·001). The independent factors associated with stress worsening were: having a me...
Introduction: Suicide is the second leading cause of death among adolescents. Suicidal behavior i... more Introduction: Suicide is the second leading cause of death among adolescents. Suicidal behavior is associated with impairments in attention. Attention can be directed toward relevant events in the environment either actively, under voluntary control, or passively, by external salient events. The extent to which the risk for suicidal behavior affects active and passive attention is largely unknown. Methods: Event-related potentials (ERPs) were recorded while 14 adolescents with acute suicidal behavior and 14 healthy controls performed an auditory 3-stimulus oddball task. The task consisted of standard (80%), target (10%), and novel (10%) stimuli. The participants were instructed to press a button upon presentation of the target. The novel stimuli were unexpected and irrelevant to the target detection task. Results: Accuracy of target detection was slightly but significantly reduced in the suicidal group. There were no significant differences in the amplitude of the target-N2 or -P3b ...
A. Basic and Translational Sleep Science VIII. Sleep and Circadian Interactions no differential i... more A. Basic and Translational Sleep Science VIII. Sleep and Circadian Interactions no differential impact on morning sleep inertia in task performance and subjective feelings (p>0.05). Conclusion: The results indicate that the artificial dusk may be a useful light modality in improving sleep quality and shortening sleep latency in healthy sleepers. While this light setting has no influence on sleep inertia after awakening in the morning. The effect of sleep inertia does vary with cognitive domains.
Background Primary care physicians and child and adolescent psychiatrists often treat sleep distu... more Background Primary care physicians and child and adolescent psychiatrists often treat sleep disturbances in children and adolescents with mood disorders using medications off-label, in the absence of clear evidence for efficacy, tolerability and short or long-term safety. This study is the first to report Canadian data about prescribing preferences and perceived effectiveness reported by child and adolescent psychiatrists regarding medications used to manage sleep disturbances in children and adolescents with depression. Methods Canadian child and adolescent psychiatrists were surveyed on their perception of effectiveness of a range of medications commonly prescribed for sleep disturbances, their ranked preferences for these medications, reasons for avoiding certain medications, and perceived side effects. Results Sixty-seven active child and adolescent psychiatrists completed the survey. Respondents reported noting significant sleep issues in 40% of all their patients. Melatonin an...
Exogenous melatonin can be used to treat sleep disturbance in adults, children, and adolescents. ... more Exogenous melatonin can be used to treat sleep disturbance in adults, children, and adolescents. While its short-term use is considered safe, there are some concerns that long-term use might delay children's sexual maturation, possibly by disrupting the decline in nocturnal melatonin levels that occur at the onset of puberty. This narrative review aimed to summarize some of the current knowledge about the potential effects of exogenous melatonin on puberty. We found no clinical studies that experimentally tested the effects of melatonin on pubertal timing in children, but we reviewed the small number of observational studies. We also drew on animal data to try to answer our question. The photoperiod and melatonin-mediated seasonal transitions in sexual activity and breeding in some mammals across the seasons have been used as a model of sexual development in mammals, including humans. The switch from non-sexual activity (in the non-breeding period) to sexual activity (in the breeding period) has been likened to the onset of puberty as there are similarities between the two. We conclude that to investigate an association between melatonin and pubertal timing, it will be important to conduct long-term randomized controlled trials of latency age children and also examine the cellular and systemslevel interactions between melatonin and kisspeptin, a recently identified neuropeptide with a locus of action at the gonadotropin releasing hormone neurons that is important in contributing to the timing of puberty onset.
Abstract Introduction Inhibitory control is essential for treatment of, and recovery from mental ... more Abstract Introduction Inhibitory control is essential for treatment of, and recovery from mental illness. An acute bout of exercise has been shown to improve inhibitory control in healthy adolescents. Purpose The primary goal was to examine the effect of an acute bout of high-intensity interval training on inhibitory control both immediately and 30-min post-exercise in adolescents hospitalized for a mental illness. Methods Participants were recruited at the Children's Hospital of Eastern Ontario. Participants performed exercise and control conditions in a randomized, counterbalanced manner. The Colour-Word Stroop Task (CWST) assessed Interference Cost (reaction time) pre, post, and 30-min post for each condition (exercise/control). The exercise condition included a 12-min HIIT circuit consisting of body weight exercises performed in a 1:1 work to rest ratio. The control condition involved reading magazines. Repeated-measures ANOVA evaluated changes in the interference cost and accuracy measures of the CWST. Results There was a significant interaction between condition and time for the interference cost measure, F(1.6,43.3) = 13.6, p Conclusion HIIT was able to improve inhibitory control by increasing response efficiency rather than improving the overall ability to respond correctly. The impact of pre-therapy HIIT to enhance focus and reduce impulsive thoughts and behaviours may improve adolescent patients’ response to mental health treatment.
The present study examines processes associated with intrusions into consciousness during an unco... more The present study examines processes associated with intrusions into consciousness during an unconscious state, natural sleep. The definition of sleep is still much debated. Almost all researchers agree that sleep onset represents a gradual loss of consciousness of the external environment. For sleep to be beneficial, it needs to remain as undisturbed as possible. Nevertheless, unlike other unconsciousness states, sleep is reversible. For purposes of survival, it is critical that the sleeper be able to "detect" and perhaps become conscious of highly relevant biological or personal information. Therefore, even in sleep, the brain must decide whether a new incoming stimulus is relevant and if so, may require an arousal to wakefulness, or whether it is irrelevant and can be gated to prevent disruption of sleep. Event-related potentials (ERPs) were used to measure the extent processing of auditory stimuli some of which elicited an ERP component, the P3a, in the waking state. The P3a is associated with processes resulting in the interruption of frontal central executive, leading to conscious awareness. Very little research has focused on the occurrence of the P3a during sleep. A multi-feature paradigm was used to examine the processing of a frequently occurring "standard" stimulus and six rarely occurring different "deviant" stimuli during wakefulness, NREM, and REM sleep. A P3a was elicited by novel environmental sounds and white noise bursts in the waking state, replicating previous studies. Other deviant stimuli (changes in pitch, intensity, duration) failed to do so. The ERPs indicated that processing of the stimuli that did not elicit a P3a in wakefulness were much inhibited during both NREM and REM sleep. Surprisingly, those deviants that did elicit a P3a in wakefulness continued to do so in stage N2 and REM sleep. The subject did not, however, awaken. These results suggest processes leading to consciousness in wakefulness may still remain active during sleep possibly allowing subjects to act on potentially highly relevant input. This may also explain how sleep can be reversed if the stimulus input is sufficiently critical.
OBJECTIVE/BACKGROUND Rates of suicide attempts in Canadian youths are concerning. Adolescence is ... more OBJECTIVE/BACKGROUND Rates of suicide attempts in Canadian youths are concerning. Adolescence is a sensitive period for the emergence of both sleep and mood problems, two major risk factors for suicidality. This naturalistic study aimed to define the sleep profile of adolescents under the combined influence of suicidality, depression and pharmacotherapy during hospitalization for a suicidal crisis. PATIENTS/METHODS Seventeen suicidal adolescents (15.0 + 1.2years, 82% females) with major depression were recruited from a Canadian pedopsychiatric inpatient unit. Seventeen non-depressed adolescents were retrospectively collated from another database (15.0 + 1.1years, 83% females). None of the participants had a history of sleep disorders or significant medical conditions. RESULTS Compared to controls, suicidal adolescents had a longer sleep onset latency (Z = -4.5, p < 0.001), longer REM latency (Z = -3.2, p = 0.001), higher percentage of NREM1 sleep t(33) = -2.6, p = 0.020), and higher REM density (Z = -2.8, p = 0.004) than controls. Higher REM density correlated with higher CDI-II scores (r = 0.55, p = 0.27) A significant interaction indicated that the two groups had similar NREM3 percentages in the first two-thirds of the night, but that the suicidal group had significantly lower NREM3 percentage than the controls in the last third of the night (F(2,66) = 3.4, p = 0.041). CONCLUSIONS Significant sleep abnormalities were observed during hospitalization for a suicidal crisis in a sample of depressed and mostly medicated adolescents. This included sleep initiation and REM sleep latency abnormalities, shallower sleep and high REM density. Future studies should decipher the relative effects of depression, suicidality and medication on sleep. These findings stress the need to address sleep disturbances in the management of suicidality in adolescents.
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent, 2018
To review sexual health screening practices during admission to an adolescent psychiatry unit. Re... more To review sexual health screening practices during admission to an adolescent psychiatry unit. Retrospective chart review of randomly selected youth admitted over a one-year period (2013). Data extracted included demographics, reasons for admission, sexual health history, as well as any comorbid behaviours noted. The main outcome measure was whether sexual health details were documented at any time during admission; if so, this information was extracted for analysis. Statistical analysis was done using univariate associations and logistic association. Mean age of subjects (n=99, 79 females and 20 males) was 15.24 years (SD = 1.30). Most common reasons for admission were suicidal gestures/self harm (n=57, 58%) and mood disorders (n=53, 54%). Thirty-seven patients (37%) had sexual health information documented in their charts. No demographic variables were significantly associated with being asked sexual health questions. Patients who had mood disorder diagnoses had 6 times the odds (...
American journal of medical genetics. Part B, Neuropsychiatric genetics : the official publication of the International Society of Psychiatric Genetics, Jan 20, 2017
White matter lesions have been described in patients with PTEN hamartoma tumor syndrome (PHTS). H... more White matter lesions have been described in patients with PTEN hamartoma tumor syndrome (PHTS). How these lesions correlate with the neurocognitive features associated with PTEN mutations, such as autism spectrum disorder (ASD) or developmental delay, has not been well established. We report nine patients with PTEN mutations and white matter changes on brain magnetic resonance imaging (MRI), eight of whom were referred for reasons other than developmental delay or ASD. Their clinical presentations ranged from asymptomatic macrocephaly with normal development/intellect, to obsessive compulsive disorder, and debilitating neurological disease. To our knowledge, this report constitutes the first detailed description of PTEN-related white matter changes in adult patients and in children with normal development and intelligence. We present a detailed assessment of the neuropsychological phenotype of our patients and discuss the relationship between the wide array of neuropsychiatric featu...
This review examines biological rhythms in persons with obsessive-compulsive disorder (OCD) and t... more This review examines biological rhythms in persons with obsessive-compulsive disorder (OCD) and their potential relevance to the pathophysiology and treatment of this disorder. In some cases of OCD, the expression of affective, cognitive, and behavioral symptoms may be influenced by circadian and seasonal rhythms, and this could possibly interact with other neurophysiological factors. Further work is required to characterize circadian profiles linked to OCD, but findings thus far highlighted delays in both the sleep-wake cycle and melatonin secretion, as well as reduced circadian rhythmicity of body temperature. It is proposed that these changes in behavioral and endogenous rhythms may increase one's vulnerability to obsessivecompulsive symptoms. Accordingly, obsessive-compulsive symptoms appear to be more severe in individuals with lower circadian amplitude and often worsen in the afternoon and evening. An increasing number of studies reported encouraging outcomes following the integration of sleep and circadian-based treatments in the management of OCD. There is a need for larger controlled trials evaluating the efficacy of chronotherapies in the context of OCD.
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